City Membership in Washtenaw Health Initiative

The council considered a resolution that allows the city of Ann Arbor to become a member of the Washtenaw Health Initiative (WHI). The resolution altered the budget for fiscal year 2013 (which began July 1, 2012) by adding $10,000 of general fund money to the budget for the office of community development – to cover the membership fee for this year. The resolution also recommends consideration of renewing the membership next year. [The city of Ann Arbor adopts budgets only one year at a time.]

A goal of WHI is to help local health care providers handle an influx of an estimated 50,000 newly insured patients when federal health care reforms take effect in 2014. The goal is to develop a plan to provide better health care for the county’s low-income residents, the uninsured and people on Medicaid – prior to changes that will be mandated by the federalPatient Protection and Affordable Care Act, recently upheld by the U.S. Supreme Court.

Currently, 2,719 people in Washtenaw County are already eligible for Medicaid but not enrolled – and of those, 958 are city of Ann Arbor residents.

The WHI is a collaboration co-chaired by former county administrator Bob Guenzel and retired University of Michigan treasurer Norman Herbert, along with Ellen Rabinowitz, executive director of the Washtenaw Health Plan. The effort is jointly sponsored by the UM Health System and Saint Joseph Mercy Health System, and facilitated by Marianne Udow-Phillips, director of the Center for Healthcare Research & Transformation – a joint venture of UM and Blue Cross Blue Shield of Michigan.

Other partners involved in the project include the Ann Arbor/Ypsilanti Regional Chamber of Commerce, Arbor Hospice, Catholic Social Services, Dawn Farm, Hope Clinic, Huron Valley Ambulance, Integrated Health Associates, Packard Health, Planned Parenthood of Mid and South Michigan, United Way of Washtenaw County, and the Women’s Center of Southeastern Michigan.

The Washtenaw County board of commissioners voted on April 4, 2012 to make the county a member of WHI – and approved the $10,000 membership fee. The city and county are two of over 30 members of WHI, who have together contributed more than $100,000 to the effort.

Washtenaw Health Initiative: Council Deliberations

Appearing before the council were Bob Guenzel, community co-chair of WHI, and Marianne Udow-Phillips, director of the Center for Healthcare Research & Transformation. CHRT is facilitating the initiative, Udow-Phillips told the council.

Sabra Briere (Ward 1) noted that when the council had been briefed about the initiative at a previous working session, councilmembers had been told they’d eventually be asked for funding. Briere asked: What will the $10,000 help accomplish? Guenzel noted that WHI has been a voluntary effort led by the two major health systems in the area – the University of Michigan Health System and Saint Joseph Mercy Health System. Guenzel continued by saying that retired Saint Joseph Mercy Health System CEO Bob Laverty had started the effort and that Udow-Phillips had provided her organization’s support. The first year and a half, Guenzel said, the entire effort had been voluntary. They’d decided they didn’t want to incorporate as a 501(c)(3).

Instead, he said, they’re asking entities to become charter members of the organization. Many of the member agencies contribute in-kind support, he said – like the hospitals and safety-net clinics. For next year, Guenzel said, they’ve developed a budget of about $100,000. That will ensure the availability of a dedicated employee from Udow-Phillips’ CHRT.

Guenzel told the council that WHI had approached the two major health systems for support and they’d agreed to help with $30,000 each. But the two health systems also wanted the community to contribute a piece of the support. Guenzel said that WHI had asked the Ann Arbor Area Community Foundation, United Way and the Washtenaw County board of commissioners for $10,000 a year. So WHI was now asking the city to contribute the same amount that the county had contributed.

Guenzel felt that this approach is effective and efficient. CHRT has made a great commitment, he said, in terms of their expertise and their ability to draw other agencies together. Whether the Affordable Health Care Act was upheld or not, Guenzel said, WHI thinks the initiative is important. The Supreme Court ruling meant that it had gotten over one hurdle, but he expected there would be others.

Guenzel concluded by allowing he’d given a long answer to Briere’s question. Briere told him it had been a good answer.

Briere followed up by asking how WHI will dovetail with what the state of Michigan does. Udow-Phillips responded to Briere’s question by saying that assuming the state moves ahead with Medicaid expansion, the WHI efforts will help the community plan to provide access to health care for those who’ll be newly insured. Even if the state does not move ahead with an expansion of Medicaid, she said, then the state or the federal government will move ahead by establishing a health care exchange. That will result in 300,000-400,000 people in Michigan who will get subsidies to buy private health insurance. Many of those people will be in Washtenaw County, she said, so by planning, the county’s health care system will be able to serve these newly-insured people.

In Washtenaw County, Udow-Philips continued, there are about 28,000 people who are uninsured. About 13,000 of those would be eligible for Medicaid under a Medicaid expansion, and most of those would be eligible for a subsidy to purchase private insurance, if that’s the route that’s taken.

Tony Derezinski (Ward 2) said he’s happy to hear this news. Ann Arbor is a great place to retire, he said, because of the quality of the health care. He asked Udow-Philips if she’d looked at other community health plans before developing an approach. She indicated that the model was Massachusetts – and the planning that Massachusetts had failed to do. When more people became eligible, there were not enough providers to give them access, she said. Massachusetts had not done the kind of planning WHI is doing in this county, she said. Once the Affordable Health Care Act was passed, the WHI organizers decided they wanted to do the necessary planning. No other counties are doing the kind of planning WHI is doing, she said. She’d like Washtenaw to be a role model for other counties in Michigan.

Carsten Hohnke (Ward 5) thanked Udow-Philips for her efforts. If it turns out that WHI determines there’s a lack of health care capacity compared to the needs of the newly-insured, Hohnke wanted to know what some of the options are for expanding that capacity. Udow-Philips told Hohnke that they’re in the final stages of that analysis right now. Both major health systems are bringing in more practitioners to Washtenaw County, she said. But it’s important to make sure those practitioners serve the Medicaid population. So WHI is working with major safety-net providers – like the Packard Clinic, Ypsilanti Family Practice and the Taubman Center – to make sure practitioners will be available. Udow-Philips stressed that not just doctors are considered practitioners – it could mean nurse practitioners, she said. The preliminary numbers would be looked at the following week, she said, to look at what the gap in capacity might be.

Outcome: The council voted unanimously to approve the $10,000 of support for the Washtenaw Health Initiative.